Provider Manual

Chapter 27: Vision Services

The EmblemHealth Vision Program, developed with EyeMed, provides routine vision management for all EmblemHealth members that have a routine vision and materials benefit. Please note that not all members have a routine vision benefit.

 

EyeMed will administer all routine exams (to determine if corrective lenses are required) and the dispensing of hardware such as frames, lenses and contact lenses based on the member’s benefit. EyeMed is responsible for the provider network including contracting and credentialing, claims processing and payment, routine vision grievances and claims appeals.*

 

*Exception: Medicare grievances and claim appeals will continue to be managed by EmblemHealth.

 

EyeMed is the vision services provider for all EmblemHealth members with a vision care benefit. This includes ASO members whose vision benefit is managed by EmblemHealth. Please note not every EmblemHealth member has a routine vision benefit. See the member’s Benefit Summary on emblemhealth.com or call EyeMed to determine if a member has vision coverage.

 

Included Membership

  1. Medicaid
  2. Medicare
  3. HIP (including members whose care is managed by Montefiore Medical Group (CMO) or HealthCare Partners (HCP) and members who selected a PCP assigned to a St. Barnabas Hospital System PCP or AdvantageCare Physicians (ACPNY).)
  4. GHI Commercial Groups with Vision Benefits (See the eligibility information on emblemhealth.com or call EyeMed to determine if a GHI member has vision coverage.)

If your patients previously got their vision benefits from Davis Vision (a.k.a.VisionWorks), GVS, EyeCare Advantage or an independent in-network provider, starting January 1, 2017, they must use an in-network EyeMed provider in order to get covered benefits (in accordance with their benefit plan.

 

Participating EyeMed providers can logon onto https://www.eyemed.com or contact EyeMed customer Service at 1-888-581-3648 to obtain member eligibility and benefit information.

 

For help finding an in-network EyeMed provider, and to ask about benefits, please share the following EyeMed Customer Service toll-free numbers with your patients:

 

1-844-790-3878 Medicare
1-877-324-2791 Medicaid
1-877-324-4063 Commercial (HMO, PPO, POS)
1-877-324-6211 On/Off Individual and Group Exchange 
and Essential Plans
TTY/TDD:711  

Information for Vision Service Providers

EyeMed is responsible for the provider network including contracting and credentialing, claims processing and payment, routine vision grievances and claims appeals.*

*Exception: Medicare grievances and claim appeals will continue to be managed by EmblemHealth.

 

If you are Interested in Joining EyeMed

Complete an online interest form found at https://provider-relations-forms.eyemedonline.com/EyeMed/NewProvider or call EyeMed’s provider service department at 1-800-521-3605.

Routine Vision Exam CPT Codes, Materials HCPCS, and Diagnosis Codes

Routine vision exam CPT codes, materials HCPCS, and diagnosis codes that should be billed to EyeMed are listed below. Claims submitted to EmblemHealth will be denied.

 

CPT Code Description
92002 Intermediate
92004 Comprehensive
92012 Intermediate
92014 Comprehensive
92015 Refraction
V2750 Standard A/R
V2750-21 A/R Tier 3
V2750-22 A/R Tier 1
V2750-25 A/R Tier 2
V2750-TG Premium A/R
S0500 Disposable Contact Lenses
V2500 –V2503 PMMA
V2510 – V2513 Gas Permeable
V2520 – V2523 Hydrophilic
V2530 – V2531 Scleral
V2599 Other Contact Lenses
V2020-V2025 Deluxe Frame
V2700 Balance Lens, Glass or Plastic
V2702 Edge Treatment (Polish or Roll)
V2702-TG Faceting
V2710 Slab-Off Prism
V2715, V2715U1, V2715U3, V2715U4 Prism
V2718, V2718U1, V2718U3, V2718U4 Fresnell Prism
V2730 Special Base Curve
V2744, V2744U1, V2744U2 Photochromic plastic (Transitions®)
V2744U5, V2744U6, V2744U7, V2744U8 Photochromic
V2745, V2745UA, V2745UB, V2745UC Tint, Solid or Gradient
V2755 UV Lens
V2760, V2760-22, V2760-TG Scratch-Resistant Coating
V2761 Mirror Coating
V2762 Polarization
V2770 Occluder Lens
V2780 Oversize Lens
V2782 Mid-Index (1.56)
V2783, V2783U1, V2783U3, V2783U4 Hi-Index (1.60+)
V2100 – V2118, V2410, V2410-22 Single Vision Lens
V2121, V2221, V2321 Lenticular
V2200 – V2220, V2299, V2430, V2430-22 Bifocal Lens
V2300 – V2320, V2399 Trifocal Lens
V2781 Plans without Fixed Pricing by Tier - Standard Progressive
V2781 S0581 Premium Progressive - Must include modifier
V2781 S0581 Progressive Tier 4 - Must include modifier
V2781-22 Progressive Tier 2
V2781-25 Progressive Tier 3
V2781-TG Progressive Tier 1
V2784 Polycarbonate Standard
V2784-22 Premium Polycarbonate

 

ICD 10 CODES Description
H52 Disorders of Refraction and Accomodation
H.52.0 Hyperopia
H52.00 Hyperopia, unspecfied eye
H52.01 Hyperopia, right eye
H52.02 Hyperopia, left eye
H52.03 Hyperopia, bilateral
H52.1 Myopia
H52.10 Myopia, unspecified eye
H52.11 Myopia, right eye
H52.12 Myopia, left eye
H52.13 Myopia, bilateral
H52.2 Astigmatism
H52.20 Unspecified astigmatism
H52.201 Unspecified astigmatism, right eye
H52.202 Unspecified astigmatism, left eye
H52.203 Unspecified astigmatism, bilateral
H52.209 Unspecified astigmatism, unspecified eye
H52.21 Irregular Astigmatism
H52.211 Irregular Astigmatism, right eye
H52.212 Irregular Astigmatism, left eye
H52.213 Irregular Astigmatism, bilateral
H52.219 Irregular Astigmatism, unsecified eye
H52.22 Regular Astigmatism
H52.221 Regular Astigmatism, right eye
H52.222 Regular Astigmatism, left eye
H52.223 Regular Astigmatism, bilateral
H52.229 Regular Astigmatism, unsecified eye
H52.31 Anisometropia
H52.32 Aniseikonia
H52.4 Presbyopia
H52.51 Internal ophthalmoplegia
H52.511 Internal ophthalmoplegia,  right eye
H52.512 Internal ophthalmoplegia, left eye
H52.513 Internal ophthalmoplegia, bilateral
H52.519 Internal ophthalmoplegia, unspecified eye
H52.52 Paresis of accommodation
H52.521 Paresis of accommodation, right eye
H52.522 Paresis of accommodation, left eye
H52.523 Paresis of accommodation, bilateral
H52.529 Paresis of accommodation, unspecified  eye
H52.53 Spasm of accommodation
H52.531 Spasm of accommodation-right eye
H52.532 Spasm of accommodation-left eye
H52.533 Spasm of accommodation-bilateral
H52.539 Spasm of accommodation-unspecified eye
H52.6 Other disorders of refraction
H52.7 Unspecified disorders of refraction
H53.0 Ambyopia
H53.00 Unspecified amblyopia
H53.001 Unspecified amblyopia, right eye
H53.002 Unspecified amblyopia, left eye
H53.003 Unspecified amblyopia, bilateral
H53.009 Unspecified amblyopia, unspecified eye
H53.01 Deprivation amblyopia
H53.011 Deprivation amblyopia, right eye
H53.012 Deprivation amblyopia, left eye
H53.013 Deprivation amblyopia, bilateral
H53.019 Deprivation amblyopia, unspecified eye
H53.02 Refractive amblyopia
H53.021 Refractive amblyopia, right eye
H53.022 Refractive amblyopia, left eye
H53.023 Refractive amblyopia, bilateral
H53.029 Refractive amblyopia, unspecified eye
H53.03 Strabismic amblyopia
H53.031 Strabismic amblyopia-right eye
H53.032 Strabismic amblyopia-left eye
H53.033 Strabismic amblyopia-bilateral
H53.039 Strabismic amblyopia-unspecified eye
H53.10 Unspecified subjective visual disturbances
H53.14 Visual Discomfort
H53.141 Visual Discomfort, right eye
H53.142 Visual Discomfort, left eye
H53.143 Visual Discomfort, bilateral
H53.149 Visual Discomfort, unspecified eye